Organization Active NPI

USA Bunnag, DDS.,PA

  • General Practice Dentistry
  • Bethesda, MD
National Provider Identifier
1124493655
Registry record updated Dec 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11494 Issued in MD
Legal business name
USA BUNNAG, DDS.,PA
Practice address
6501 Democracy Blvd
Bethesda, MD 20817-1685
Phone
(301) 896-0633
Fax
(301) 896-0633
NPI assigned
Dec 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. USA Bunnag, DDS
Title
President
Phone
(301) 896-0633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 11494 MD Primary

Addresses

Primary practice location

6501 Democracy Blvd
Bethesda, MD 20817-1685

Mailing address

6501 Democracy Blvd
Bethesda, MD 20817-1685
Phone (301) 896-0633

Other identifiers 1

IdentifierTypeStateIssuer
699949200MedicaidMD

Other names 1

  • Bunnag Comprehensive Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

6501 Democracy Blvd
Bethesda, MD 20817
Phone (301) 896-0633

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449619200000",
    "number": "1124493655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 DEMOCRACY BLVD",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208171685",
            "telephone_number": "301-896-0633",
            "fax_number": "301-896-0633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 DEMOCRACY BLVD",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208171685",
            "telephone_number": "301-896-0633",
            "fax_number": "301-896-0633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USA BUNNAG, DDS.,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-09",
        "last_updated": "2015-12-09",
        "status": "A",
        "authorized_official_last_name": "BUNNAG",
        "authorized_official_first_name": "USA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-896-0633",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "11494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "699949200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bunnag Comprehensive Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bethesda, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.